The United States Public Health Services (PHS) provides clinicians and healthcare systems with evidence- based practices for tobacco control and treatment through widely disseminated guidelines ("PHS Guidelines"). Interventions as brief as three minutes can significantly increase quit rates among adult daily smokers. Despite an estimated three million college student smokers in the U.S., the majority of who have made at least one quit attempt, little research exists on college students and smoking cessation. Although the PHS Guidelines have been widely disseminated and are intended to be implemented in a variety of clinical settings, student health clinics do not appear to have fully adopted these strategies. Student health clinics provide care to a large number of students, making them an ideal setting to encourage tobacco cessation in this population. This proposal seeks to provide formative data testing the implementation of evidence-based tobacco cessation strategies in student health clinics on college campuses in North Carolina. Specific aims are to: (1) Increase student health centers'organizational adoption and implementation of the PHS Guidelines through system- level changes;and (2) Increase college student health care providers'adoption and implementation of the PHS Guidelines to promote tobacco cessation behaviors among college student tobacco users. A Secondary Aim is to preliminarily assess the efficacy of implementing the PHS Guidelines in student health centers on students'readiness to quit to estimate sample sizes for a future larger efficacy trial. Using a clinic-level randomized design, the intervention targets both organizations providing healthcare and clinicians within those organizations through system-level changes and increased provider training. The intervention will be evaluated using key informant interviews, environmental scans, provider surveys, and patient exit surveys. The proposed pilot study will mark the first time implementation of the PHS Guidelines has been tested in a college student health center setting. Results will be used to: (1) estimate effect sizes for a future trial that will test both implementation and efficacy in a larger sample;and (2) inform implementation of this intervention in other clinical settings, including community colleges. The proposed research study responds to an unmet need for the successful implementation of evidence-based tobacco cessation strategies for college students. The overall intent of this research is to ultimately close the gap between research discovery and program delivery in the area of tobacco control. PUBLIC HEALTH RELEVANCE: Despite an estimated three million college student smokers in the U.S., little is known about college students and smoking cessation. The United States Public Health Services has widely disseminated guidelines for tobacco treatment which are intended to be implemented in a variety of clinical settings;however, student health clinics do not appear to have fully adopted these strategies. The goal of the proposed research is to test the implementation of evidence-based tobacco cessation strategies in student health clinics on college campuses.